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Wed Apr 23 13:05:56 BST 2008

Change the focus and ask the questions.  A fully consious patient has a tender abdomen following a GSW and also needs a blood transfusion.   The patient refuses both, yet the doctor insists the patient should not die on his shift.  Does the doctor have the right to sedate the patent so as to remove the objections, with the sole purpose of doing a laparotomy and giving blood.   Autotomy and equipose.  

K

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-----Original Message-----
From: Matt Oliver <moliverzw at gmail.com>

Date: Wed, 23 Apr 2008 21:21:30 
To:"'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Subject: RE: Lawsuits, etc

What is the point of an email discussion list if views on the subject cannot
be aired? Sure we don't have all the information but it is an interesting
topic. I see nothing to be gained by trying suppress discussion. 

For those who are so shocked that the patient dared to sue, how much
autonomy do you allow a fully conscious sentient patient? Rectal exam is not
the only way to assess spinal cord injury as far as I am aware. The patient
had every right to refuse the examination and to take whatever legal action
he saw fit if his request was forcibly denied.

Matt Oliver
Bendigo
Australia

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Marc Matthews - MedPro MMC X
Sent: Wednesday, 23 April 2008 6:52 AM
To: Trauma & Critical Care mailing list
Subject: RE: Lawsuits, etc

This chain of e-mails needs to cease and desist immediately. There is
discoverable material in each of your e-mails. The appeals process and this
Mr. Persuad's legal counsel might just find these e-mails very helpful to a
new case as this is a public website. 

As you are all experts, your opinions do matter, however, your opinions may
matter so much that they might find their way into this person's appeals
process and in a higher court. You are actually giving them material. You
are become our own worst enemy and our colleague's worst enemy. It is over .
. . Let it be. 

Please,

MRM

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-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Charlene M Morris
Sent: Tuesday, April 22, 2008 1:40 PM
To: Trauma &amp, Critical Care mailing list
Subject: Lawsuits, etc

What do you think CYA stands for? Cover your *ss?! How about "call your
attorney"?.

And as one lawyer once told me: anyone can you for ANYthing. And ER is a
high risk place for just that.

Still, to forcibly perform an invasive exam on someone...I just do not know.
And you are correct: I was not there. I have been in many other similar
situations and do the best I can with what I have at hand.

CMM

On 4/22/08, Moore, Rick <Rick.Moore at triadhospitals.com> wrote:
>
> Once again someone taking incomplete and possibly incorrect 
> information and making judgments. You weren't there, don't know the 
> extent of the patients injuries or the reasoning of the physician for 
> insisting. If we accept a refusal we are sued for not convincing them 
> refusal is a bad thing, if we don't accept a refusal we are 
> criticized, sued or arrested for assault.
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of 
> bowwow49 at bellsouth.net
> Sent: Tuesday, April 22, 2008 2:39 PM
> To: Trauma & Critical Care mailing list
> Subject: Re: Rectal Exam Lawsuit DENIED
>
> And in the same frame as when a women says no, it means NO, not maybe, 
> correct ! What is the difference when a man says no, and it makes no 
> difference in this world what the Dr's opinion was, if this man did 
> indeed say not only no, but begged for this not to be done, this is 
> still , at least as of right now ,The United States of America people 
> and it is his right and any one on this list that feels there MD 
> overrules the free choice of a adult that is Awake Alert and oriented 
> , should not only be found liable, but further more there should have 
> been charges filed against this doctor, not the pt that was being 
> assaulted just because this ER doctor was pissed because someone 
> lacking the proper information of why this might have needed to be 
> done had the ignorance to refuse his judgment ! This kind of situation 
> is just as responsible for lawsuits as the BS crap that comes up ! Come on
folks !
> Bowser
> -------------- Original message from "Charlene M Morris"
> <cvmmorris at gmail.com>: --------------
>
>
> > Apart from the ramifications of an exam the clinician feels is 
> > necessary, I am STILL of the mind that patients have rights and 
> > responsibilities. In this instance, I would have documented in bold
> > letters: "PATIENT DECLINES [OR REFUSES] RECTAL EXAM DESPITE STATING 
> > ITS IMPORTANCE IN HIS CASE FOR DETECTING NEUROLOGICAL DEFICIT".
> > Whether that holds up in a COURT OF LAW is yet another issue.
> >
> > I once worked with a Dr. who wanted to do a breast exam on ALL women.
> > His nurse defended his committment to detecting breast cancer, but 
> > to my mind-- if a woman (PATIENT) says no, she should NOT be 
> > subjected to
> what the Dr.
> > *felt* necessary..
> >
> > JMO--
> >
> > Charlene Morris
> >
> >
> > On 4/22/08, Jeffery Hammond wrote:
> > >
> > > I guess it's time to agree to disagree. :)
> > >
> > > JSH
> > >
> > > -----Original Message-----
> > > From: trauma-list-bounces at trauma.org [mailto:
> > > trauma-list-bounces at trauma.org]
> > > On Behalf Of Moore, Rick
> > > Sent: Tuesday, April 22, 2008 1:30 PM
> > > To: Trauma & Critical Care mailing list
> > > Subject: RE: [ccm-l] RE: Rectal Exam Lawsuit DENIED
> > >
> > >
> > > Gee, I didn't hear any indignation about "passing judgment in a 
> > > situation where we have very limited information" directed towards 
> > > the other comments that were uniformly condemning lawyers and 
> > > praising the "good guys."
> > >
> > > That's because until your comments nobody had been indignant 
> > > calling
>
> > > the procedure unwarranted, unnecessary and hogwash, again based on 
> > > only one limited side of the story. All conclusions that no one 
> > > other than those close to the case with all the information should
> make.
> > >
> > > -----Original Message-----
> > > From: trauma-list-bounces at trauma.org 
> > > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Jeffery 
> > > Hammond
> > > Sent: Tuesday, April 22, 2008 12:01 PM
> > > To: 'Trauma & Critical Care mailing list'
> > > Cc: 'CCML'
> > > Subject: RE: [ccm-l] RE: Rectal Exam Lawsuit DENIED
> > >
> > > Replies below to Dr Myers comments...
> > >
> > > -----Original Message-----
> > > From: Jeff Myers, D.O., Ed.M. [mailto:myersj at alum.rpi.edu]
> > > Sent: Tuesday, April 22, 2008 12:38 PM
> > > To: Jeffery Hammond
> > > Cc: 'Trauma & Critical Care mailing list'; 'CCML'
> > > Subject: Re: [ccm-l] RE: Rectal Exam Lawsuit DENIED
> > >
> > > Remember all, we are getting the lay press' report of the events 
> > > and
>
> > > armchair quarterbacking the incident.
> > >
> > > -->>Agreed
> > >
> > > All I glen was that this patient was struck in the head at a 
> > > construction site. Was the treating team concerned about a head 
> > > and
> c-spine injury?
> > >
> > > -->> You don't need a rectal exam for an injury limited to the 
> > > -->> head
> > > in a patient moving all 4 extremities.
> > >
> > > Were they concerned the patient was combative / ? altered from the 
> > > head injury?
> > >
> > > -->> He was apparently talking to them. He didn't become
> > > combative
> > > until they tried to bugger him.
> > >
> > > The patient was not only sedated but intubated (according to the
> > > description) - doesn't this scenario occur across the country when 
> > > we are taking care of altered trauma patients so we can obtain 
> > > timely imaging and intervene rapidly?
> > >
> > > -->> Yes, in heavily intoxicated patients or those with major
> > > TBI.
> > > But, in this case (agreeing that we have only part of the data) I 
> > > would counsel any trauma team member who intubated a patient just 
> > > to
>
> > > do a rectal exam.
> > >
> > > I just ask you all to reflect on situations where you may have 
> > > done the same thing as reported because you were doing the right 
> > > thing for the patient before passing judgment in a situation where 
> > > we have
>
> > > very limited information.
> > >
> > > -->> Gee, I didn't hear any indignation about "passing judgment
> > > in a situation where we have very limited information" directed 
> > > towards the other comments that were uniformly condeming lawyers 
> > > and
>
> > > praising the "good guys."
> > >
> > > Jeffrey Hammond MD, MNPH
> > > New Brunswick, NJ
> > >
> > >
> > >
> > >
> > >
> > > --
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> > >
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